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4.
Viana do Castelo; s.n; 20220106. il., tab..
Tese em Português | BDENF - Enfermagem, BDENF - Enfermagem | ID: biblio-1364047

RESUMO

A formação contínua e o desenvolvimento profissional são referidos na literatura como fatores essenciais para atingir e manter uma prestação de cuidados baseada na evidência e, consequentemente, cuidados de excelência. Todos os profissionais que prestam cuidados à pessoa em situação crítica, nomeadamente na Equipa de Emergência Médica Intra-Hospitalar (EEMI), têm a responsabilidade de aprofundar e manter atualizadas as suas competências em reanimação, onde a possibilidade de sobrevivência da pessoa em situação crítica, nomeadamente com bradicardia extrema, depende da eficácia da resposta à emergência. Considerando que a simulação no ensino de enfermagem é identificada como uma estratégia de formação de excelência em cuidados de saúde, esta promove a melhoria das competências e capacidades técnicas e não técnicas, reproduzindo em ambiente controlado situações reais. Este estudo tem como objetivo verificar os contributos da prática simulada nos ganhos percebidos e na satisfação dos Enfermeiros que integram a da EEMI, num Serviço de Urgência Básico (SUB), em contexto de bradicardia extrema. Para tal, foi desenvolvido um estudo quase-experimental, com desenho antes/após, de grupo único integrando uma amostra de oito enfermeiros, distribuídos em equipas de dois elementos. Numa fase preliminar, utilizou-se um questionário para validar a pertinência e viabilidade do estudo. Na segunda fase foi criada e validada uma grelha de observação de Competências Técnicas (GOCBE) que constituiu o instrumento de colheita de dados, juntamente com uma grelha de observação de Competências Não Técnicas Baseada em Ações, Escala de Ganhos Percebidos com as Experiências Clínicas Simuladas (EGPSA) e Escala de Satisfação com as Experiências Clínicas Simuladas (ESECS) validadas para a população portuguesa. As competências das equipas foram avaliadas pela sua exposição a um cenário simulado antes e depois (pós-teste) da participação no mesmo. Como resultados, observa-se um aumento da média global da GOCBE no 3º e 4º grupo, do 1º para o 2º momento (1,32 para 1,51 e 1,25 para 1,61, respetivamente). O grupo 2 manteve a mesma média e o grupo 1 diminuiu do 1º para o 2º momento de 1,44 para 1,04. Quanto às competências não técnicas, verifica-se um aumento das pontuações médias, do 1º para o 2º momento, em todos os grupos, sendo a competência não técnica "Comunicação" a que apresentou um maior aumento entre o 1º e 2º momento, em todos os grupos, de 0,58 para 0,89. Relativamente aos ganhos percebidos, constata-se um aumento dos valores médios, do 1º momento para o 2º momento, tanto na escala global, como nas suas cinco dimensões, particularmente, na dimensão Cognitiva e Interventiva, observando-se diferenças estatisticamente significativas, tanto na escala global (p=0,018), como nas suas dimensões, exceto na dimensão Atitudinal, que apesar da média ser superior no 2º momento, não se verificaram mudanças significativas entre as duas avaliações. Na satisfação com a intervenção (prática simulada), globalmente os enfermeiros da EEMI, mostraram-se muito satisfeitos, correspondendo à máxima pontuação da escala (10 pontos), constatando-se também nas suas três dimensões. Não se verificaram diferenças estatisticamente significativas entre o tempo de atividade profissional no SUB e a satisfação dos enfermeiros e não se encontrou correlação entre a satisfação dos enfermeiros e os ganhos percebidos após a intervenção. Considerando os resultados deste estudo, apesar de circunscritos a um contexto e com uma amostra bastante limitada, em alinhamento com a literatura, vislumbra-se que esta estratégia de formação contínua pode promover a aquisição e desenvolvimento de competências profissionais nos enfermeiros das EEMI, para uma intervenção de mais qualidade, designadamente, perante a pessoa em situação de bradicardia extrema.


Continuing education and professional development are referred to in the literature as essential factors to achieve and maintain evidence-based care and, consequently, excellent care. All professionals who provide care to a person in critical condition, namely in the Intra-Hospital Medical Emergency Team (EEMI), have the responsibility to deepen and update their skills in resuscitation, where the possibility of survival of the person in a critical situation, particularly with extreme bradycardia, it depends on the effectiveness of the emergency response. Considering that simulation in nursing education is identified as an excellent training strategy in health care, it promotes the improvement of technical and non-technical skills and abilities, reproducing real situations in a controlled environment. This study aims to check the contributions of simulated practice in the perceived gains and satisfaction of nurses who are part of the EEMI, in a Basic Emergency Service (SUB), in a context of extreme bradycardia. To this end, it was developed a quasi-experimental study, with a before/after design, of a single group, included a sample of eight nurses, distributed in teams of two elements. In a preliminary phase, a questionnaire was used to validate the relevance and feasibility of the study. In the second phase, a Technical Skills Observation Grid (GOCBE) was created and validated as a data collection instrument, along with an Action-Based Non-Technical Skills Observation Grid, Scale of Perceived Gains with Simulated Clinical Experiences (EGPSA) and the Satisfaction with Simulated Clinical Experiences Scale (ESECS) validated for the Portuguese population. The teams' skills were assessed by their exposure to a simulated scenario before and after (post-test) participation in it. As a result, there is an increase in the global average of GOCBE in the 3rd and 4th group, from the 1st to the 2nd moment (1.32 to 1.51 and 1.25 to 1.61, respectively). Group 2 maintained the same mean and group 1 decreased from the 1st to the 2nd moment from 1.44 to 1.04. As for non-technical skills, there is an increase in average scores, from the 1st to the 2nd moment, in all groups, with the non-technical competence "Communication" showing the greatest increase between the 1st and 2nd moment, in all the groups, from 0.58 to 0.89. Regarding perceived gains, there is an increase in the average values, from the 1st to the 2nd moment, both on the global scale and in its five dimensions, particularly in the Cognitive and Interventional dimension, observing statistically significant differences, both in the global scale (p=0.018), as in its dimensions, except for the Attitudinal dimension, which despite the average being higher in the 2nd moment, there were no significant changes between the two assessments. In terms of satisfaction with the intervention (simulated practice), overall, the EEMI nurses were very satisfied, corresponding to the maximum score on the scale (10 points), also found in its three dimensions. There were no statistically significant differences between the length of professional activity in the SUB and the nurses' satisfaction, and no correlation was found between the nurses' satisfaction and the gains perceived after the intervention. Considering the results of this study, despite being limited to a context and with a very limited sample, in line with the literature, it is clear that this continuing education strategy can promote the acquisition and development of professional skills in EEMI nurses, for a intervention of higher quality, namely, before the person in a situation of extreme bradycardia.


Assuntos
Bradicardia , Autonomia Profissional , Educação Continuada , Emergências
5.
J Surg Educ ; 79(3): 574-578, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34972669

RESUMO

OBJECTIVE: Toolkits to assess progressive resident autonomy are integral to the movement toward competency-based surgical education. OpTrust is one such tool validated for intraoperative assessment of both faculty and resident entrustment behaviors. We developed a supplementary tool to OpTrust that would aid faculty and residents in making meaningful improvements in entrustment behavior by providing talking points and reflection items tailored to different motivational styles as defined by Regulatory Focus Theory (RFT). DESIGN: Existing literature about surgical entrustment was used to build a list of sample dialogue and self-reflection items to use in the operating room. This list was distributed as a survey to individuals familiar with OpTrust and RFT, asking them to categorize each item as Promotion-oriented, Prevention-oriented, or Either. The respondents then met to discuss survey items that did not reach a consensus until the group agreed on their categorization. SETTING: University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin Michigan Medicine, Ann Arbor, Michigan PARTICIPANTS: Clinician and education researchers familiar with intraoperative entrustment and RFT RESULTS: Eight respondents completed the survey categorizing the talking points and reflection items by RFT (100% response rate). Six of these respondents attended the additional meeting to discuss discordant items. The input from this panel was used to develop "TrustEd," the supplementary tool that faculty and residents can quickly reference before beginning a case. CONCLUSION: Although tools such as OpTrust allow intraoperative entrustment behaviors to be quantified, TrustEd offers concrete strategies for faculty and residents who are interested in improving those behaviors over time. Further study is needed to assess whether the use of TrustEd does in fact lead to durable behavior change and improvement in OpTrust scores.


Assuntos
Internato e Residência , Competência Clínica , Docentes de Medicina , Humanos , Autonomia Profissional , Confiança
6.
J Nurs Res ; 30(1): e191, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35050955

RESUMO

BACKGROUND: Little is known regarding the factors that affect the team-based practice of nurse practitioners (NPs). Examining the relationships between these factors and team-based practice may provide important insights into the strength of the NP practice. PURPOSE: This study was designed to examine the effects of practice autonomy and leadership style on the team-based practice of acute care NPs working in hospitals. METHODS: A cross-sectional, national survey design was conducted to examine the autonomy, leadership, and team-based practice of NPs. One thousand three hundred ninety-one NPs completed the questionnaire, which included demographic and practice variables, the Dempster Practice Behavior Scale, the Multifactor Leadership Questionnaire, and the NP-physician relations subscale of the Nurse Practitioner Primary Care Organizational Climate Questionnaire. The hierarchical linear model was used to differentiate between the NP-level and organization-level effects on team-based practice. Multiple regression was applied to explore the factors associated with team-based practice. RESULTS: The hierarchical linear model results identified no organization-level effect on team-based practice. Moreover, the results of the regression model found that NPs with greater autonomy in actualization, empowerment and readiness, and idealized influence leadership style enhanced the performance of the doctor of medicine-NP team-based practice. The final model explained 39% of the variance in doctor of medicine-NP team-based practice. Autonomy in actualization and empowerment were identified as the two most important predictors. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The practice autonomy and leadership style of NPs influence the efficiency of team-based practice in Taiwan. To improve the team-based practice of NPs, healthcare administrators must support the practice autonomy of NPs.


Assuntos
Profissionais de Enfermagem , Autonomia Profissional , Estudos Transversais , Humanos , Liderança , Atenção Primária à Saúde , Taiwan
7.
Artigo em Inglês | MEDLINE | ID: mdl-35055482

RESUMO

Although there is considerable literature on job satisfaction among nurses in various settings, there is little research about contributing factors, including moral distress to job satisfaction among a certain group of nurses, such as nurses acting as physician assistants. The purpose of this study was to verify the impact of nurse-physician collaboration, moral distress, and professional autonomy on job satisfaction among nurses acting as physician assistants. Descriptive and correlational research was conducted on a convenience sample of 130 nurses from five general hospitals in South Korea. In the final regression model, the adjusted R square was significant, explaining 38.2% of the variance of job satisfaction (F = 8.303, p < 0.001), where 'cooperativeness' (ß = 0.469, p = 0.001) from nurse-physician collaboration, 'institutional and contextual factor' from moral distress (ß = -0.292, p = 0.014), and professional autonomy (ß = 0.247, p = 0.015) were included. In hospital environments, a more cooperative inter-professional relationship between nurses and physicians led to less moral distress caused by organisational constraints. A higher level of professional autonomy among nurses acting as physician assistants is required to increase their job satisfaction.


Assuntos
Assistentes Médicos , Médicos , Estudos Transversais , Humanos , Satisfação no Emprego , Princípios Morais , Autonomia Profissional , Inquéritos e Questionários
8.
J Nurs Manag ; 30(1): 252-259, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34605107

RESUMO

AIM: This study aimed to describe nurses' experiences of working as members of unit practice councils. BACKGROUND: Health care organisations worldwide want personnel to participate in decision-making. Unit practice councils promote unit-level decision-making over unit-specific issues. Despite extensive research on shared decision-making, few studies have examined the experiences of nurses serving as members of these councils. METHODS: A descriptive qualitative study design was used with semi-structured interviews of 16 nurses in two clinics of a Finnish university hospital. Interviews were analysed using thematic analysis. RESULTS: The analysis revealed two themes describing nurses' experiences as members of unit practice councils: (i) inchoate unit practice councils with insufficient allocated working time and (ii) partial empowerment of nurses through the organisation's evolving Magnet project. CONCLUSIONS: Unit practice councils in the studied organisations are inchoate and unable to effectively advance shared decision-making or support nurses' professional autonomy. In the future, the councils require constant support from all leadership levels of the organisation. IMPLICATIONS FOR NURSING MANAGEMENT: Sharing decision-making power could be a win-win situation where nurse leaders relinquishing power over certain matters gain time to immerse in wider issues. While acknowledging different organisational roles, there is room for trusting each other's professionality and respecting autonomous work.


Assuntos
Liderança , Enfermeiras e Enfermeiros , Empoderamento , Humanos , Autonomia Profissional , Pesquisa Qualitativa
9.
J Surg Educ ; 79(2): 469-474, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34602380

RESUMO

OBJECTIVE: Accurate recognition of patient-related complexity of an operation is critical for appropriate surgical decision making. It is not yet understood whether general surgery residents are able to accurately assess the relative complexity of a given operative case. This study investigates the agreement of case complexity ratings between residents and attending surgeons and explores whether resident-related factors correlate with any discordance in perception of patient-related operative complexity. DESIGN: Residents and attending surgeons rated the relative complexity of completed cases on a 3 point scale via the SIMPL (Society for Improving Medical Professional Learning) operative assessment smartphone app. Additional trainee demographic data, autonomy ratings, and performance ratings were also obtained from the SIMPL registry for each rated case. Complexity agreement was defined as an equal rating between the resident and attending and assigned a value of zero. Over-estimate ratings were assigned a positive value and under-estimate ratings were assigned a negative value. Trends in complexity agreement were analyzed using descriptive statistics and mixed-effects models. RESULTS: A total of 43,179 general surgery cases were rated by 1946 categorical general surgery residents and 1520 attending surgeons between 2015 and 2020. Residents and attendings agreed on case complexity in 63.23% of cases, while the residents overestimated complexity in 13.37% of cases and underestimated complexity in 23.40% of cases. Every level of resident except post-graduate year 2 had similar rates of agreement about the complexity of a procedure, while residents who received a higher autonomy rating were more likely to be in agreement with the faculty raters (OR 1.12, 95% CI 1.06-1.19). CONCLUSIONS: The results of this study suggest that general surgery residents inaccurately perceive the patient-related complexity of a given case approximately one third of the time. Greater experience and operative autonomy appear to be associated with higher complexity agreement. Future research into factors influencing perceived case complexity may provide insight into how to best implement new teaching for surgical residents regarding the concept of case complexity.


Assuntos
Cirurgia Geral , Internato e Residência , Aplicativos Móveis , Cirurgiões , Competência Clínica , Cirurgia Geral/educação , Humanos , Autonomia Profissional
10.
J Surg Educ ; 79(2): 431-440, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34758932

RESUMO

OBJECTIVE: To better understand the resident perceived faculty factors associated with the promotion of resident operative skill and autonomy DESIGN: Qualitative retrospective analysis utilizing anonymous open-ended comments from residents on department of surgery faculty teaching evaluations and cross references them to observed faculty entrustment scores SETTING: Single tertiary midwestern allopathic academic medical center using data obtained between January 2016-August 2019 PARTICIPANTS: Forty-six resident and fourteen faculty surgeons from general, plastic, thoracic, and vascular surgery sections. RESULTS: Themes of personal traits, the working environment created, and teaching techniques employed were identified across resident promoting attendings and resident limiting attendings. Promoting attendings employed preoperative goal setting, increased operative autonomy, and postoperative feedback while creating environments conducive to learning by promoting teamwork and collaboration. Alternatively, limiting attendings used more ineffective teaching techniques including micromanaging, lack of delegation, and treating residents as observers. Additionally, trainees described these operating room environments as stressful and strained. CONCLUSIONS: Qualitative analysis of resident teaching evaluations of attending surgeons highlights the importance of relationships between learner and teacher, the learning environment, and teaching techniques. Continuous professional development programs centered on entrustment and promoting behaviors have the potential to disseminate strategies to enhance educator skills among surgeons.


Assuntos
Cirurgia Geral , Internato e Residência , Cirurgiões , Competência Clínica , Docentes de Medicina , Cirurgia Geral/educação , Humanos , Autonomia Profissional , Estudos Retrospectivos
11.
Am Surg ; 88(3): 332-338, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34786966

RESUMO

In 1982 Dean Warren delivered the presidential address "Not for the Profession… For the People" in which he identified substandard surgical residency programs graduating residents who were unable to pass American Board of Surgery exams. Drs. Warren and Shires as members of the independent ACGME began to close the substandard programs in order to improve surgical care for average Americans i.e. "for the people". By 2003 these changes dramatically reduced the failure rate for the ABS exams and trained good surgeons who could operate independently however the residents were on duty for every other or every third night. In 2003 the ACGME mandated duty hour restrictions in order improve resident wellness and improve the training environment for the profession. However, work hour restrictions reduced the time surgical residents spent in the hospital environment primarily when residents had more autonomy and had exposure to emergency cases which degraded readiness for independent practice. Surgical educators in the 2 decades after the work hour restrictions have improved techniques of training so graduates could not only pass the board exams but also be prepared for independent practice. Surgical residency training has improved by both the changes implemented by the independent ACGME in 1981 and by the work hour restrictions mandated in 2003. Five recommendations are made to ensure that Dr Warren's culture of excellence in surgical training continues in an environment that enhances wellbeing of the trainee i.e. "For the People and the Profession".


Assuntos
Acreditação/normas , Educação de Pós-Graduação em Medicina/normas , Cirurgia Geral/educação , Internato e Residência/normas , Admissão e Escalonamento de Pessoal/normas , Cirurgiões/educação , Comitês Consultivos , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/história , Educação de Pós-Graduação em Medicina/organização & administração , Cirurgia Geral/história , Cirurgia Geral/normas , História do Século XX , História do Século XXI , Humanos , Internato e Residência/história , Internato e Residência/organização & administração , Admissão e Escalonamento de Pessoal/história , Autonomia Profissional , Melhoria de Qualidade , Cirurgiões/normas , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/normas , Estados Unidos
13.
Surgery ; 171(3): 598-606, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34844760

RESUMO

BACKGROUND: The amount of time surgical trainees spend operating independently has been reduced by work-hour restrictions and shifts in the health care environment that impede autonomy. Few studies evaluate the association between clinical outcome and resident autonomy. METHODS: The Veterans Affairs Surgical Quality Improvement Program database was queried to identify patients undergoing partial colectomy for neoplasm between 2004 and 2019. Rectal resections, emergency procedures, and those involving postgraduate year 1 and 2 residents were excluded. Records were categorized as performed with the attending scrubbed or not scrubbed. Hierarchical logistic regression was used to identify factors independently associated with operative time, morbidity, and mortality. RESULTS: In total, 7,347 patients met inclusion criteria; 6,890 (93.6%) were categorized as attending scrubbed and 457 (6.4%) as attending not scrubbed. The cohorts were similar in terms of patient demographics, including age, race, body mass index, and American Society of Anesthesiologists class. There were no differences between cohorts in terms of operative time (attending not scrubbed 3.02 hours, attending scrubbed 3.07 hours, P = .42). On hierarchical logistic regression adjusted for age, gender, race, body mass index, functional status, cancer location, facility operative level, wound class, American Society of Anesthesiologists class, length of operation, operative modality (open or minimally invasive), postgraduate year of resident, and year, there were no differences in odds of complications, major morbidity, or mortality based on attending involvement. CONCLUSION: Colectomies performed by residents with appropriate levels of autonomy are efficient and safe. Our results indicate that attending surgeon judgment regarding resident autonomy is sound and that educational environments can be designed to foster resident independence and preserve clinical quality, safety, and efficiency.


Assuntos
Colectomia/educação , Neoplasias do Colo/cirurgia , Internato e Residência , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Autonomia Profissional , Idoso , Colectomia/efeitos adversos , Neoplasias do Colo/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Melhoria de Qualidade , Estudos Retrospectivos , Resultado do Tratamento
14.
J Surg Educ ; 79(2): 524-530, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34782271

RESUMO

OBJECTIVE: Gender disparities have demonstrated influence on several areas of medical trainee academic performance and surgeon professional attainment. The impact of gender on perceived operative autonomy and performance of urology residents is not well understood. This single-institution pilot study explores this relationship by evaluating urology faculty and resident assessment of resident operative autonomy and performance using the Society for Improving Medical Professional Learning app. DESIGN: Using Society for Improving Medical Professional Learning, trainees in a single urology residency program were assessed in operative cases on three scales (autonomy, performance, and case complexity). Intraoperative assessments were completed by both faculty and residents (self-evaluation). Respective evaluations were compared to explore differences in ratings by gender. SETTING: University of Michigan Health, Ann Arbor, MI. PARTICIPANTS: University of Michigan Urology Residents and Faculty. RESULTS: A total of 516 evaluations were submitted from 18 urology residents and 20 urology faculty. Self-reported ratings among female and male residents did not differ significantly for autonomy (p = 0.20) or performance (p = 0.82). Female and male residents received overall similar autonomy ratings that were not significantly different from female faculty (p = 0.66) and male faculty (p = 0.81). For female residents, there was no significant difference in performance ratings by faculty gender (p = 0.20). This finding was consistent when the resident was male (p = 0.70). CONCLUSIONS: At our institution, there is no overall gender-based difference in self-rated or faculty-rated operative autonomy or performance among urology trainees. Understanding relevant facets of institutional culture as well as educational strategies between faculty and residents may identify factors contributing to this outcome.


Assuntos
Cirurgia Geral , Internato e Residência , Urologia , Competência Clínica , Docentes de Medicina , Feminino , Cirurgia Geral/educação , Humanos , Masculino , Projetos Piloto , Autonomia Profissional
15.
Ann Surg ; 275(1): e264-e270, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32224741

RESUMO

OBJECTIVE: To identify what strategies supervisors use to entrust autonomy during surgical procedures and to clarify the consequences of each strategy for a resident's level of autonomy. BACKGROUND: Entrusting autonomy is at the core of teaching and learning surgical procedures. The better the level of autonomy matches the learning needs of residents, the steeper their learning curves. However, entrusting too much autonomy endangers patient outcome, while entrusting too little autonomy results in expertise gaps at the end of training. Understanding how supervisors regulate autonomy during surgical procedures is essential to improve intraoperative learning without compromising patient outcome. METHODS: In an observational study, all the verbal and nonverbal interactions of 6 different supervisors and residents were captured by cameras. Using the iterative inductive process of conversational analysis, each supervisor initiative to guide the resident was identified, categorized, and analyzed to determine how supervisors affect autonomy of residents. RESULTS: In the end, all the 475 behaviors of supervisors to regulate autonomy in this study could be classified into 4 categories and nine strategies: I) Evaluate the progress of the procedure: inspection (1), request for information (2), and expressing their expert opinion (3); II) Influence decision-making: explore (4), suggest (5), or declare the next decision (6); III) Influence the manual ongoing action: adjust (7), or stop the resident's manual activity (8); IV) take over (9). CONCLUSIONS: This study provides new insights into how supervisors regulate autonomy in the operating room. This insight is useful toward analyzing whether supervisors meet learning needs of residents as effectively as possible.


Assuntos
Competência Clínica , Internato e Residência/métodos , Aprendizagem , Salas Cirúrgicas/normas , Autonomia Profissional , Pesquisadores/normas , Humanos , Estudos Retrospectivos
16.
Health Promot Int ; 37(1)2022 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-34171926

RESUMO

In spite of the overwhelming evidence that highlights the effectiveness of routine vaccination, an increasing number of people are refusing to follow recommended vaccination schedules. While the majority of research in this area has focussed on vaccine hesitancy in parents, there is little research on the factors that promote vaccine hesitancy in health care providers (HCPs). Identifying factors that promote vaccine hesitancy in HCPs is essential because it may help broaden our understanding of vaccine hesitancy in patients. Therefore, the goal of this investigation was to review 21 studies and examine how professional autonomy and risk perception may promote vaccine acceptance, rejection and delay in physicians and nurses. We found that vaccine hesitant nurses and physicians shared similar views towards vaccines; both groups believed that their decision to vaccinate was separate from their role as an HCP. This belief comprised of three themes: decisional autonomy, personal risk perception and alternatives to vaccination. Both groups believed that mandatory vaccine policies reduced their ability to decide whether vaccination was in their best interests. We argue that decisional autonomy may weaken risk perception of disease, which in turn may encourage beliefs and behaviours that reinforce a 'hero persona' that reduces appropriate preventive and hygiene measures. We employ the Health Belief Model to discuss the crucial role that risk perceptions may play in reinforcing autonomy in vaccine hesitant physician and nurses. We conclude this paper by providing a set of recommendations that aim to improve the decision-making process surrounding mandatory vaccinations for HCPs.


Assuntos
Pessoal de Saúde , Autonomia Profissional , Vacinação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa , Vacinas
17.
Am J Surg ; 223(1): 53-57, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34332743

RESUMO

BACKGROUND: Effects of the institutional macrocosm on general surgery resident wellbeing have not been well studied. We sought to identify organizational factors that impact resident wellness and burnout. METHODS: Using a modified Delphi technique, an open-ended survey and two subsequent iterations were distributed to wellness stakeholders at two institutions to identify and stratify institutional factors in six burnout domains. RESULTS: Response rates for each survey round were 29/106 (27%), 30/46 (65%) and 21/30 (70%). Top factors identified in each domain were: CONCLUSION: A modified Delphi technique prioritized institutional wellness and burnout factors. Top factors identified were compensation, vacation time, and autonomy. These results can direct future scholarship of barriers/facilitators of resident wellbeing.


Assuntos
Esgotamento Profissional/epidemiologia , Cirurgia Geral/educação , Internato e Residência/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Esgotamento Profissional/prevenção & controle , Técnica Delfos , Feminino , Cirurgia Geral/estatística & dados numéricos , Humanos , Internato e Residência/economia , Masculino , Mentores/psicologia , Mentores/estatística & dados numéricos , Autonomia Profissional , Fatores de Risco , Salários e Benefícios/estatística & dados numéricos , Cirurgiões/educação , Cirurgiões/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
18.
Esc. Anna Nery Rev. Enferm ; 26: e20210070, 2022.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1346054

RESUMO

Resumo Objetivo analisar os estilos e fatores intervenientes na gestão e liderança de enfermeiros em três países, Brasil, Portugal e Espanha, à luz da Burocracia Profissional. Método estudo exploratório e descritivo de abordagem qualitativa realizado em três hospitais universitários localizados em diferentes países: Brasil, Espanha e Portugal. Participaram da pesquisa 30 enfermeiros. Os dados foram coletados por meio de um roteiro de coleta de dados com questões sociodemográficas e entrevistas analisadas com auxílio do software WebQda. Resultados diferentes percepções sobre os elementos integradores da participação foram reveladas nos três países, destacando-se a comunicação em diversas óticas. Verificou-se algumas convergências em relação ao trabalho em equipe, sendo a confiança o elemento que impulsiona e motiva a equipe. Sinaliza-se para uma relação participativa no desenvolvimento do trabalho. Conclusão e implicações para a prática foi possível identificar, nos três países, a importância da comunicação no processo de gestão, bem como dos estilos de gestão e de liderança, como elementos que oportunizam a atuação da equipe. Também foi evidenciada a presença de fatores intervenientes de relevância, tais como escuta, clima organizacional, relação interpessoal, transparência no trabalho e delegação de funções, os quais envolvem a burocracia profissional em que o conhecimento do enfermeiro possibilita o exercício de suas habilidades de forma horizontalizada e participativa.


Resumen Objetivo analizar los estilos y factores implicados en la gestión y el liderazgo de enfermeros en tres países, Brasil, Portugal y España, a la luz de la Burocracia Profesional. Método estudio descriptivo exploratorio con abordaje cualitativo realizado en tres hospitales universitarios ubicados en diferentes países: Brasil, España y Portugal. Treinta enfermeros participaron en la investigación. Los datos fueron recolectados a través de un script de recopilación de datos con preguntas sociodemográficas y entrevistas analizadas con la utilización del software WebQda. Resultados se revelaron diferentes percepciones sobre los elementos integradores de la participación en los tres países, destacando la comunicación desde diferentes perspectivas. Se constataron algunas convergencias en relación al trabajo en equipo, siendo la confianza el elemento que impulsa y motiva al equipo. Se advierte una relación participativa en el desarrollo del trabajo. Conclusión e implicaciones para la práctica se pudo advertir, en los tres países, la importancia de la comunicación en el proceso de gestión, así como los estilos de gestión y liderazgo, como elementos que permiten mejorar el desempeño del equipo. También se evidenciaron factores intervinientes relevantes, como la escucha, el clima organizacional, la relación interpersonal, la transparencia en el trabajo y la delegación de funciones, que conforman la burocracia profesional en la cual el conocimiento de los enfermos les permite el despliegue de sus competencias de manera horizontal y participativa.


Abstract Objective to analyze the styles and factors involved in nurses' management and leadership in three countries, Brazil, Portugal and Spain, in the light of Professional Bureaucracy. Method a descriptive and exploratory study with a qualitative approach carried out in three university hospitals located in different countries, namely: Brazil, Spain and Portugal. Thirty nurses participated in the research. Data was collected through a collection script with sociodemographic questions and interviews analyzed using the WebQda software. Results different perceptions about the integrating elements of participation in the three countries were revealed, highlighting communication from different perspectives. Some convergences in relation to teamwork were verified, where trust was the element that drives and motivates the team. It is a participatory relationship in the development of work. Conclusion and implications for the practice in the three countries, it was possible to identify the importance of communication in the management process, as well as the management and leadership styles, as elements that favor performance of the team. Presence of relevant intervening factors was also evidenced, such as choice, organizational climate, interpersonal relationships, transparency in work and delegation of functions, which involves professional bureaucracy in which the nurses' knowledge allows them to exercise their skills in a horizontal and participatory manner.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Gestão em Saúde , Capacidade de Liderança e Governança , Liderança , Enfermeiras e Enfermeiros , Equipe de Assistência ao Paciente , Portugal/etnologia , Prática Profissional , Qualidade da Assistência à Saúde , Espanha/etnologia , Brasil/etnologia , Autonomia Profissional , Comunicação , Pesquisa Qualitativa , Educação Continuada , Integralidade em Saúde , Relações Interprofissionais
19.
REVISA (Online) ; 11(1): 36-41, 2022.
Artigo em Português | LILACS | ID: biblio-1354280

RESUMO

Objetivo: identificar a importância e atuação dos enfermeiros no fluxo de atendimentos a pacientes com suspeita ou COVID-19 confirmados em serviço de Urgência e Emergência. Método: estudo de revisão integrativa da literatura. Tratase de um estudo realizado por meio de levantamento bibliográfico e baseado na experiência vivenciada pelas autoras. Resultados: os enfermeiros que atuam nas emergências, são importantes para o direcionamento dos fluxos de atendimento de acordo com a gravidade da doença e na assistência direta. A criação dos fluxos são diárias e mudam constantemente, portanto a adequação de protocolos e fluxo é essencial para o enfrentamento da pandemia, sendo marcante a presença de enfermeiros nesse processo. Conclusões: a atuação do enfermeiro no prontoatendimento, em meio à pandemia da COVID- 19, desenvolve ações de assistência, gerencia além da participação na formalização e implantação de fluxos, protocolos e normas para o setor, evidencia- se- como essencial o seu papel nos serviços de saúde.


Objective: to identify the importance and role of nurses in the flow of care to patients with suspected or COVID-19 confirmed in na Urgent and Emergency service. Methods: study of na integrative literature review. This is a study carried out through a bibliographic survey and based on the authors´ experience. Results: nurses working in emergencies are importante in directing care flows according to the severity of the disease and in direct care. The cretion of flows is daily and changes constantly, so the adequacy of protocols and flow is essential to face the pandemic, with the presence of nurses in this process being remarkable. Conclusions: the role of nurses in emergency care, in the midst of the COVID- 19 pandemic, develops care, management actions, in addition to participating in the formalization and implementation of flows, protocols and standards for the sector, its essential role in the health service


Objetivo: identificar la importância y rol del enfermeiro em el flujo de atención a pacientes com sospecha o COVID- 19 confirmado em um servicio de Urgencias y Emergencias. Métodos: estúdio de una revisión integradora de la literatura. Se trata de um estúdio realizado através de um relevamiento bibliográfico y basado em la experiência de los autores. Resultados: las enfermeiras que trabajan en emergências son importantes para orientar los flujos de atención según la gravedad de la enfermedad y en la atención directa. La creaciõn de flujos es diária y cambia constantemente, por lo que la adecuación de los protocolos y el flujo es fundamental para enfrentar la pandemia, siendo destacable la presencia de enfermeiras em este proceso. Conclusiones: el rol del enfermeiro em la atención de emergências, em médio de la pandemia COVID -19, desarrolha acciones de atención, gestión, además de participar em la formalización e implementación de flujos, protocolos y estándares para el sector, su rol fundamental em la Servicio de salud.


Assuntos
Humanos , Enfermeiros , Autonomia Profissional , COVID-19 , Serviços de Saúde
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